Issue link: https://beckershealthcare.uberflip.com/i/415620
21 Executive Briefing: Outpatient Total Knee Replacement Sponsored by: T raditionally, total knee replacement has been a procedure that required patients to spend three to five days, 1 or more, at the hospital after sur- gery, and then often additional time in re- covery facilities before heading home, still not completely steady on their new joints. 2 Now, more and more surgeons are consider- ing performing these total knee procedures in an outpatient setting. A recent survey at a major medical conference indicated that 69 percent of orthopedic surgeons intend to start performing outpatient total knee re- placement surgery. 3 One key reason for this change is advanc- es in technology, one of which is the Con- forMIS iTotal knee replacement. iTotal is a customized implant produced to fit individ- ual patient anatomy based on a CT scan of each patient's knee. Surgeons send their patients' images to the company and receive customized implants within a few weeks. The customization fits patients bet- ter so there is a reduced risk for residual pain from wrong-sized implants and by matching the patient's unique J-curves, the implant offers the potential to result in a "forgotten" and more stable knee. 4 , 5 "Patients are demanding we move proce- dures into the outpatient setting and we are able to deliver those services because of technology development," says Richard G. Buch, MD, of The Dallas Limb Resto- ration Center. "In the past 10 years, there weren't any major leaps and bounds with joint replacement, but now with the Con- forMIS technology, we are taking great strides forward." "Two years ago, I started doing the outpa- tient procedures in the hospital, earmark- ing patients who I thought I could treat with just an overnight stay at the hospital. If they needed to stay an extra day they could, it wasn't a big deal," says William Berghoff, MD, of ONE Ortho Northeast in Fort Wayne, Ind. "Now we can almost pre- dict those who are good candidates for the outpatient setting and those who aren't." Moving patients to the ASC There are three qualities Dr. Berghoff al- ways looks for in patient selection for the outpatient setting, beyond the usual pe- rimeters: • Motivation — Do they want a rapid recovery? • Anesthesia — Can this person safely undergo regional blocks? Can the anesthesiologists at the ASC perform them? • Technique — Will less invasive tech- niques help the patient? Is the phy- sician confident in performing these techniques? Before the ConforMIS technology, Dr. Buch and his team experimented with outpatient total knee replacements with mixed results. Most of the patients had to stay in the hospital more than 24 hours for rehabilitation. "With the old knee replacements, people spent three to four days in the hospital, and around 20 percent of them also then had to go to a recovery home," he says. "Then I happened on the ConforMIS technology and began using it with my patients. Now pa- tients go home 70 percent of the time on the first or second day after surgery, and none of them go to the recovery center. That's a major change." Dr. Buch also speculates that the de- creased amount of bone-cutting and the specific fit of the ConforMIS implant leads Outpatient TKR: Critical Factors Enabling Successful TKR Procedures in ASCs By Laura Dyrda Dr. Richard Buch Dr. William Berghoff Dr. Peter Gleiberman